Contrast agent--associated nephrotoxicity.

Abstract:

:Radiocontrast media can lead to a reversible form of acute renal failure that begins soon after the contrast dye administration and generally is benign. Contrast media accounts for 10% of all causes of hospital-acquired acute renal failure and represents the third leading cause of in-hospital renal function deterioration after decreased renal perfusion and postoperative renal insufficiency. The in-hospital mortality rate in patients developing renal insufficiency is related directly to the magnitude increase of serum creatinine concentration. The mortality rate ranges from 3.8% with an increase in serum creatinine level of 0.5 to 0.9 mg/dL to 64% with an increase of greater than 3.0 mg/dL. The mechanism by which contrast-induced renal failure occurs is not well understood. Contrast agent-associated nephrotoxicity appears to be a result of direct contrast-induced renal tubular epithelial cell toxicity and renal medullary ischemia. Furthermore, a key mechanism seems to be alteration in renal dynamics, probably caused by imbalances between vasodilator and vasoconstrictor factors, including the activities of nitric oxide, prostaglandins, endothelin, and reactive oxygen species. The optimal strategy to prevent contrast-associated nephrotoxicity remains uncertain. At present, recommendations are as follows: (1) periprocedural hydration, (2) use of a low-osmolality contrast, and (3) limiting the amount of contrast agent. Recently, considerable interest has resulted from the preliminary positive data on the effectiveness of prophylactic administration of acetylcysteine and fenoldopam. The former may prevent the direct oxidative tissue damage, whereas the latter is a selective intrarenal vasodilator.

journal_name

Prog Cardiovasc Dis

authors

Briguori C,Tavano D,Colombo A

doi

10.1053/pcad.2003.YPCAD16

subject

Has Abstract

pub_date

2003-05-01 00:00:00

pages

493-503

issue

6

eissn

0033-0620

issn

1873-1740

pii

S0033062003500093

journal_volume

45

pub_type

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